Annals of surgery
-
Comparative Study
Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors.
Gastric gastrointestinal stromal tumors (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of minimally invasive resection of gastric GIST has been established, the long-term safety and efficacy of these techniques are unclear. We hypothesized that complete resection of gastric GISTs using a combination of laparoscopic or laparoendoscopic techniques results in low perioperative morbidity and an effective long-term control of the disease. ⋯ A laparoscopic approach to surgical resection of gastric GIST is associated with low morbidity and short hospitalization. As found in historical series of open operative resection, the tumor mitotic index predicts local recurrence. The long-term disease-free survival of 92% in our study establishes laparoscopic resection as safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by minimally invasive surgery, a laparoscopic approach may be the preferred resection technique in most patients with small- and medium-sized gastric GISTs.
-
Randomized Controlled Trial
Laparoscopic skills are improved with LapMentor training: results of a randomized, double-blinded study.
To determine if prior training on the LapMentor laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment. ⋯ This study demonstrates that prior training on the LapMentor laparoscopic simulator leads to improved resident performance of basic skills in the animate operating room environment. This work marks the first prospective, randomized evaluation of the LapMentor simulator, and provides evidence that LapMentor training may lead to improved operating room performance.
-
Comparative Study
Short-term hyperglycemia in surgical patients and a study of related cellular mechanisms.
To examine cellular mechanisms by which short-term elevations of glucose or insulin impair leukocyte functions and to assess the occurrence of perioperative hyperglycemia in surgical patients. ⋯ Both short-term hyperglycemia and hyperinsulinemia are associated with significantly decreased monocyte HLA-DR expression, a parameter correlating with infectious complications and patient mortality. This may provide a mechanism by which high glucose and insulin impair innate immunity. It also appears that perioperative maintenance of normoglycemia will become a valid performance measure for practicing surgical specialists.